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The Mediastinum (including pre-and para-spinal lines, neural tumours, and pneumomediastinum).
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Chronic mediastinitis may lead to mediastinal fibrosis and a fixed mediastinum (see also ps. 2.7 - 8 & 2.27 - 29), venous, including SVC, obstruction (ps. 9.6 - 7), pulmonary and arterial and venous obstruction, tracheal and bronchial narrowing, enlarged mediastinal nodes which may become calcified, and pleural effusions. Sometimes the fibrosis may extend to involve the oesophagus or the coronary vessels. Fibrosis may extend into or predominate in the hilar regions where it may be bilateral or unilateral.
Surgical and endovenous treatment of superior vena cava syndrome
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Manju Kalra, Haraldur Bjarnason, Peter Gloviczki
Thrombolysis may be performed alone for acute SVC thrombosis related to indwelling catheters or prior to angioplasty/stenting to resolve the thrombosis and reveal the underlying stenotic lesion for definitive treatment. If thrombolysis is determined to be appropriate prior to PTA or stenting, a suitable-length catheter with side holes is placed across the lesion for catheter-directed lytic therapy. Successful catheter-directed thrombolysis as well as pharmacomechanical thrombectomy have been reported not only in various catheter-related thromboses, but also in malignant SVC occlusions.38 For details of thrombolytic therapy, refer to Chapters 24 and 25. The need for post-procedure anticoagulation is also individualized based on the cause of SVC syndrome. The majority of patients, especially those with malignancy and catheter-related thrombosis, receive oral anticoagulation at least for a few months until the stent is lined with pseudointima and the risk of re-thrombosis decreases. Patients with mediastinal fibrosis are often treated with antiplatelet therapy alone. Both rethrombosis following the cessation of anticoagulation as well as excellent results without have been reported.39,40
Radiation-induced lung disease
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Max M Weder, M Patricia Rivera
Chylothorax refers to the presence of lymphatic fluid in the pleural space, caused by a leak of the thoracic duct or one of its divisions. This condition usually occurs as a consequence of chest trauma, as an iatrogenic complication of chest or head and neck surgery, oesophageal sclerotherapy, central venous cannulation, or as a result of tumour invasion in the setting of metastatic cancer, lymphoma or chronic lymphocytic leukaemia. Chylothorax is a rare complication of radiation therapy and has been reported in patients with lymphoma, non-small-cell lung cancer and oesophageal cancer. The latency period may be considerable and chylothorax has been observed to occur as late as 23 years after completion of radiation therapy.28 The exact pathophysiologic mechanism of radiation-induced chylothorax is unknown. Mechanical lymphatic obstruction due to radiation-induced mediastinal fibrosis is one possible aetiology.
Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy
Published in Expert Review of Cardiovascular Therapy, 2023
Tahir S Kafil, Tom Kai Ming Wang, Ankit Agrawal, Muhammad Majid, Alveena B Syed, Erika Hutt, Ben Alencherry, Joshua A Cohen, Sachin Kumar, Agam Bansal, Brian P Griffin, Allan L Klein
Other conditions such as sarcoidosis can have associated inflammation in mediastinal and hilar lymph nodes, as well as active pulmonary disease. Cardiac sarcoidosis can rarely present with pericardial involvement, but more frequently presents as myocarditis. Clinical signs suggestive of CP in sarcoidosis patients may be caused by mediastinal fibrosis encompassing heart, large vessels, and bronchi. IgG-4 related disease is another etiology associated with extra-cardiac deposits of inflammation. The imaging of structures adjacent to the pericardium or in periphery when available in the field of vision of CMR or FDG-PET can allow for the diagnosis of these conditions and potential etiologies. Treatment of pericardial disease due to specific autoimmune etiologies such as sarcoidosis, SLE or IgG-4 have dedicated treatments targeted specifically for those conditions.
Radiologic mimics of pulmonary embolism
Published in Postgraduate Medicine, 2021
However, because V/Q scanning is a form of functional imaging that does not delineate thoracic architecture, it has a number of limitations. ‘False-positive’ V/Q scans can be seen in conditions which lead to extrinsic compression of the pulmonary arteries (PA). These include mediastinal adenopathy, including tuberculosis and other indolent infections, sarcoidosis, cancer, and bronchiectasis, as well as mediastinal fibrosis [8–11] and aortic aneurysm [12]. Pulmonic vein stenosis, an occasional complication of atrial radiofrequency ablation, has been reported to resemble PE [13,14]. Finally, pulmonary hemorrhage can also appear similar to PE on perfusion scanning, which can complicate the clinical scenario not only because the treatment for PE would lead to worsening of hemorrhage, but also because conditions which predispose patients to pulmonary hemorrhage, such as systemic lupus erythematosus, also increase the risk for venous thromboembolism [15,16]. To a great extent, most of these conditions can be accurately evaluated and delineated from PE with CT scanning.